A Brief History of Paediatric Pharmacotherapy
While optimal treatment remains elusive for a number of serious paediatric conditions, children and youth currently benefit from a large array of safe and effective therapies for common and important diseases, ranging from meningitis to cancer. Given the current breadth and depth of available paediatric therapeutics, it may difficult to appreciate just how recent many of these transformative medical innovations have been, and how far therapy for children has advanced in a relatively short period of time.
Since the dawn of time and until the 1930’s, childhood was a dangerous time. In most countries, the mortality rate for children up the age of five was often upwards of 25% (1,2). As recently as 1920, in the United Kingdom, the mortality rate for children under 5 years of age was 15% (3), with the majority of deaths due to bacterial and viral infections. Thankfully, over the last century, this grim reality has changed, with under-4 mortality in the UK now reported at 0.77 per 1000 children. While improved public sanitation and highly effective mass vaccination programs are responsible for the majority of this decrease, disease specific therapy (1) has also contributed to significant improvements in childhood survival have driven.
This article reviews the history of paediatric pharmacotherapy, highlighting some of the unique challenges faced in the pursuit of paediatric-specific drugs, outlining the specific challenges that continue to impede drug development for infants, children and youth, and offering system-focused recommendations to forward safe and effective medications for this population in the future.